Jared Peeler Soccer Academy
Jared Peeler Soccer Academy offers training for players, ages 5-14, of all skill levels, aimed at improving
individual technical skills as well as tactical decision-making skills. The coaching staff will help campers
raise their skill level using fun and challenging drills, demonstrations, and individual instruction.
This camp also offers numerous opportunities for fun and competitive games.
Each camper will be responsible for providing their own soccer ball and is encouraged to bring a sports
drink and small snack to every camp session. Water will be provided.
Camp Director
Camp Director, and Dickson County native, Jared Peeler is the head coach and co-founder of D.C.
United, a competitive travel soccer team for high school aged boys in Dickson County. He holds a
certified national coaching license. He is also a former NAIA Division I all-conference player, 2001 TransSouth Conference Champion and player of the year for Martin Methodist College.
Please return completed registration form with payment and waiver to:
Jared Peeler
505 Lillian Court
White Bluff, TN 37187
Make checks payable to Jared Peeler Soccer Academy
Name: __________________________ _____ Age: _____
____ Male
____ Female
Address: ____________________________________________________________
City: ____________________
State: _____
Parent’s Name(s): _______________________________
Zip: ______________
Phone #: ________________________
E-mail address: ________________________________________________________
Emergency Contact Person: ______________________________________________
Emergency Contact Number: _____________________________________________
Goalkeeper:
Yes _______
No _______
Camp Price
Camp cost is $50 per camper
Make checks payable to Jared Peeler Soccer Academy
Registration Deadline is June 11, 2012
Late registration will take place on site, the first day of camp at 8:00 a.m. Any registration received after
June 11, 2012 will need to have a $5.00 late fee added to the price of camp.
Location and Times
All sessions will be held at Dickson Buckner Park Soccer Complex, June 18-21, 2012.
Sessions will begin at 9:00 a.m. and end at 12:00 p.m. Based on the number of campers and in order
to give campers more individual instruction, an afternoon session may be added.
If an afternoon session is added, it will be for boys and will begin at 1:00 p.m. and end at 4:00 p.m.
In this case, the morning session will be reserved for the girl campers.
You will be informed which session your camper is in via e-mail or phone on or before June 13,
2012.
Contact Information
E-mail: jaredpeeler9@gmail.com
Work: (615) 740-5775
Cell: (615) 812-9636
I understand that the amount to be paid is for the designated dates and covers camp tuition.
Medical Release
In consideration for the opportunity to participate in the Jared Peeler Soccer Academy, I voluntarily
agree to assume all risks involved in my child’s participation in the Soccer Camp and all related
activities. I understand that if I allow my child to participate, my child may be exposed to risks of
personal injury and/or property damage or loss. I also recognize that there are both foreseeable
and unforeseeable risks of injury that may occur, which the camp cannot specifically anticipate and
list here.
Release of Liability
I release all members of the Jared Peeler Soccer Academy from any and all liability, claims, costs,
expenses, injuries, and/or losses that I or my child may sustain as a result of my child’s
participation in the Jared Peeler Soccer Academy. I certify by my signature below that I am this
child’s parent or legal guardian. I sign this document freely and voluntarily.
__________________________________________________________________________________________________________________
Parent or Guardian’s Signature
Date